Healthcare Provider Details

I. General information

NPI: 1457052631
Provider Name (Legal Business Name): CHARIENEZ SANTOS CRUZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 W REDONDO BEACH BLVD
GARDENA CA
90247-3511
US

IV. Provider business mailing address

11645 209TH ST APT 7
LAKEWOOD CA
90715-1379
US

V. Phone/Fax

Practice location:
  • Phone: 310-532-4200
  • Fax:
Mailing address:
  • Phone: 562-881-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: